دورية أكاديمية
The association of rocuronium dosing and first-attempt intubation success in adult emergency department patients.
| العنوان: | The association of rocuronium dosing and first-attempt intubation success in adult emergency department patients. |
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| المؤلفون: | Levin NM; Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA. Nicholas.levin@hsc.utah.edu., Fix ML; Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA., April MD; Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA., Arana AA; The United Stated Army Institute of Surgical Research, San Antonio, TX, USA., Brown CA 3rd; Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. |
| مؤلفون مشاركون: | NEAR Investigators |
| المصدر: | CJEM [CJEM] 2021 Jul; Vol. 23 (4), pp. 518-527. Date of Electronic Publication: 2021 Apr 10. |
| نوع المنشور: | Journal Article; Observational Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer Country of Publication: England NLM ID: 100893237 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1481-8043 (Electronic) Linking ISSN: 14818035 NLM ISO Abbreviation: CJEM Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2021- : [London] : Springer Original Publication: Ottawa : Canadian Medical Association, c1999- |
| مواضيع طبية MeSH: | Intubation, Intratracheal* , Laryngoscopes*, Adult ; Emergency Service, Hospital ; Humans ; Laryngoscopy ; Rocuronium |
| مستخلص: | Background: The recommended rocuronium dose for rapid sequence intubation is 1.0 mg/kg; however, the optimal dose for emergency airway management is not clear. We assessed the relationship between rocuronium dose and first-attempt success among emergency department (ED) patients undergoing rapid sequence intubation. Methods: This is a secondary analysis of the National Emergency Airway Registry (NEAR), an observational 25-center registry of ED intubations. Ninety percent recording compliance was required from each site for data inclusion. We included all patients > 14 years of age who received rocuronium for rapid sequence intubation from 1 Jan 2016 to 31 Dec 2018. We compared first-attempt success between encounters using alternative rocuronium doses (< 1.0, 1.0-1.1, 1.2-1.3 and ≥1.4 mg/kg). We performed logistic regressions to control for predictors of difficult airways, indication, pre-intubation hemodynamics, operator, body habitus and device. We also performed subgroup analyses stratified by device (direct vs. video laryngoscopy). We calculated univariate descriptive statistics and odds ratios (OR) from multivariable logistic regressions with cluster-adjusted 95% confidence intervals (CI). Results: 19,071 encounters were recorded during the 3-year period. Of these, 8,034 utilized rocuronium for rapid sequence intubation. Overall, first attempt success was 88.4% for < 1.0 mg/kg, 88.1% for 1.0-1.1 mg/kg, 89.7% for 1.2-1.3 mg/kg, and 92.2% for ≥1.4 mg/kg. Logistic regression demonstrated that when direct laryngoscopy was used and when compared to the standard dosing range of 1.0-1.1 mg/kg, the adjusted odds of a first attempt success was significantly higher in ≥1.4 mg/kg group at 1.9 (95% CI 1.3-2.7) relative to the other dosing ranges, OR 0.9 (95% CI 0.7-1.2) for < 1.0 mg/kg and OR 1.2 (95% CI 0.9-1.7) for the 1.2-1.3 mg/kg group. First-attempt success was similar across all rocuronium doses among patients utilizing video laryngoscopy. Patients who were hypotensive (SBP < 100 mmHg) prior to intubation had higher first-attempt success 94.9% versus 88.6% when higher doses of rocuronium were used. The rates of all peri-intubation adverse events and desaturation were similar between dosing groups, laryngoscope type utilized and varying pre-intubation hemodynamics. Conclusions: Rocuronium dosed ≥1.4 mg/kg was associated with higher first attempt success when using direct laryngoscopy and among patients with pre-intubation hypotension with no increase in adverse events. We recommend further prospective evaluation of the dosing of rocuronium prior to offering definitive clinical guidance. |
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| فهرسة مساهمة: | Keywords: Airway; Critical care; Depolarizing paralytics; Emergency medicine; Non-depolarizing paralytics; Rapid sequence intubation Local Abstract: [Publisher, French] RéSUMé: CONTEXTE: La dose de rocuronium recommandée pour l'intubation à séquence rapide est de 1,0 mg / kg, mais la dose optimale pour la prise en charge des voies respiratoires d'urgence n'est pas claire. Nous avons évalué la relation entre la dose de rocuronium et la réussite de la première tentative chez les patients des services d'urgence soumis à une intubation à séquence rapide. MéTHODES : Il s'agit d'une analyse secondaire du National Emergency Airway Registry (NEAR), un registre d'observation des intubations aux urgences dans 25 centres. Pour que les données soient prises en compte, chaque site devait respecter 90 % des enregistrements. Nous avons inclus tous les patients âgés de plus de 14 ans qui ont reçu du rocuronium pour une intubation à séquence rapide du 1er janvier 2016 au 31 décembre 2018. Nous avons comparé le succès de la première tentative entre les rencontres utilisant des doses alternatives de rocuronium (<1,0 mg/kg, 1,0-1,1 mg/kg, 1,2-1,3 mg/kg et 1,4mg/kg). Nous avons effectué des régressions logistiques pour contrôler les facteurs prédictifs des voies aériennes difficiles, l'indication, l'hémodynamique pré-intubation, l'opérateur, l'habitus corporel et le dispositif. Nous avons également effectué des analyses de sous-groupes stratifiées par dispositif (laryngoscopie directe contre vidéo-laryngoscopie). Nous avons calculé des statistiques descriptives univariées et des rapports des cotes (RC) à partir de régressions logistiques multivariables avec des intervalles de confiance (IC) à 95 % ajustés par groupe RéSULTATS: 19 071 consultations ont été enregistrées au cours de la période de trois ans. Parmi celles-ci, 8 034 ont utilisé du rocuronium pour une intubation à séquence rapide. Dans l’ensemble, le succès de la première tentative était de 88,4 % pour <1,0 mg/kg, 88,1 % pour 1,0 à 1,1 mg/kg, 89,7 % pour 1,2 à 1,3 mg/kg et 92,2 % pour ≥1,4 mg/kg. La régression logistique a démontré que lorsque la laryngoscopie directe était utilisée et comparée à la gamme de dosage standard de 1,0-1,1 mg/kg, la probabilité ajustée de réussite de la première tentative était significativement plus élevée dans le groupe ≥ 1,4mg/kg à 1,9 (IC 95 % 1,3-2,7) par rapport aux autres gammes de dosage, RC 0,9 (IC 95 % 0,7-1,2) pour < 1,0 mg/kg et RC 1,2 (IC 95 % 0,9-1,7) pour le groupe 1,2-1,3 mg/kg. La réussite de la première tentative était similaire pour toutes les doses de rocuronium chez les patients utilisant la vidéo-laryngoscopie. Les patients qui étaient hypotendus (SBP <100 mmHg) avant l'intubation avaient un taux de réussite de la première tentative plus élevé 94,9% contre 88,6% lorsque des doses plus élevées de rocuronium étaient utilisées. Les taux de tous les effets indésirables péri-intubation et de désaturation étaient similaires entre les groupes de dosage, le type de laryngoscope utilisé et les différentes hémodynamiques pré-intubation CONCLUSIONS: Le rocuronium dosé à ≥1,4mg/kg a été associé à une meilleure réussite de la première tentative lors de l'utilisation de la laryngoscopie directe et chez les patients présentant une hypotension avant intubation, sans augmentation des effets indésirables. Nous recommandons une évaluation prospective plus poussée du dosage du rocuronium avant de proposer une orientation clinique définitive. |
| المشرفين على المادة: | WRE554RFEZ (Rocuronium) |
| تواريخ الأحداث: | Date Created: 20210410 Date Completed: 20211025 Latest Revision: 20230325 |
| رمز التحديث: | 20230327 |
| DOI: | 10.1007/s43678-021-00119-6 |
| PMID: | 33837951 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. | تدمد: | 1481-8043 |
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| DOI: | 10.1007/s43678-021-00119-6 |